Computerized medical insurance system including means to automatically update member eligibility files at pre-established intervals

ABSTRACT

The computerized insurance claim processing system links the physician&#39;s office and the provider of insurance coverage by means of a central administration computer. The system provides up-to-date information to the provider of health care services as to insurance coverage of a patient. The system also allows real time modification of the information, including the identity of patients covered and the type of insurance benefits.

This application is a division of application Ser. No. 068,240, filedJune 30, 1987.

The invention relates to computerized systems for processing insuranceclaims.

BACKGROUND OF THE INVENTION

A type of processing system for medical insurance claims is discussed inU.S. Pat. No. 4,491,725, issued to Pritchard, on Jan. 1, 1985. Thispatent is incorporated by reference. The patent discusses a system inwhich a patient seeking medical treatment presents an identificationcard at a physician's office. Coded data is electronically read from thecard, and transmitted to a central brokerage computer. The brokeragecomputer ascertains from a data base whether the patient is covered byan insurance policy, and, if so, whether the policy will fully pay forthe medical treatment sought by the patient. The brokerage computerinforms the physician immediately of the information found. The patentfurther discusses various types of funds transfer which can occur aspayment for the medical treatment.

However, this patent does not appear to address the question of (1) Howthe information contained in the data base is derived, and (2) How andwhen the information in the data base is updated. The latter questioncan significantly affect the cost incurred by an employer in providing agroup medical insurance plan for its employees. For example, the database contains a roster of insured employees which must be updated asemployees leave the employing company. However, because of variousdelays, some rosters are updated only once per month. This monthlyupdating has the result that an employee leaving the service of acompany nevertheless retains the ability, whether intended or not, toobtain treatment under the medical insurance coverage until his name isremoved from the roster. If a month is assumed to contain thirty days,then, on average, every employee who leaves the employment of a companyretains insurance coverage for fifteen days afterward, at the employer'sexpense.

In addition, there is another possible source of expense to employersbased on departing employees. The Consolidated Omnibus BudgetReconcillation Act of 1985 (COBRA) (P.L. 99-272) requires that, undercertain circumstances, an employer must continue an employee's insurancecoverage after terminating employment.

Both the occurrence of late roster updating, together with the existenceof COBRA, create complications when a former employee seeks medicalcare, because they create uncertainty as to the insurance coverage ofthe employee. It is very important that the treating physician knowwhether the employee has insurance benefits.

OBJECT OF THE INVENTION

It is an object of the invention to provide an improved system for theadministration of medical insurance claims.

SUMMARY OF THE INVENTION

In one form of the invention, a third party maintains a data base in anadministration computer. The data base includes a comprehensive rosterof all persons having insurance benefits under a given insurance plan,as well as the types of benefits available, including the particularmedical treatments which are reimbursible by insurance, and the dollarvalue of the reimbursement for each treatment. A treating physician hascommunication equipment which can communicate in real time with theadministration computer in order to ascertain whether a given patient ison the roster of covered individuals for a given insurance plan, andwhether a proposed treatment is reimbursible, as well as the amount ofreimbursement. If the data base indicates that the proposed treatment isin fact covered, the physician can request that the amount ofreimbursement be immediately credited to him, as by a funds transfer tohis bank.

An employer, who provides the insurance coverage for the benefit of anemployee-patient, also has communication equipment which can link to theadministration computer, but in a different manner than that of thephysician: the employer can modify, in real time, the data base. Forexample, an employer can add and delete persons to the roster of thoseinsured, as people enter and leave his employment. Further, the employercan change the benefits which the plan provides. For example, he maychange the reimbursement amount for treatment of a sprained wrist from Xdollar to Y dollars.

Further, the employer can audit the activity of his insurance plan asreported by the data base. For example, he can track, by addressing thedata base, the insurance claim activity of each insured individual.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a simplified overview of the system.

FIGS. 2, 2A-2C, 3A-3C, 4 and 5 illustrate a flow chart which describesthe operation of parts of the system of FIG. 1.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 depicts a simplified overview of one form of the invention. Anadministration computer 3 maintains a data base for each insurance planprovided by an employer. File 6 indicates the data base for plan ABCmaintained by employer Alpha Company. The file includes a roster of allinsured employees of Alpha Company, their spouses and dependents. Inaddition, the file includes a list of all medical treatments for whichinsurance compensation is available. (Each treatment is typically calleda diagnosis, because the physician usually undertakes a diagnosis priorto embarking upon the treatment which the diagnosis indicates. Anexample would be a diagnosis of a sprained wrist in a patient Adam,followed by the treatment considered proper under the circumstances.)The file also contains a list of dollar amounts payable for each type ofdiagnosis. For example, in the file, X dollars is associated with thediagnosis for sprained wrist, meaning that insurance plan ABC will pay Xdollars for the treatment of a sprained wrist.

When a patient 9 visits a physician for treatment of the sprained wrist,the patient 9 presents an identification card 15 as evidence that thepatient is covered by insurance plan ABC. The physician, using dataterminal 18, communicates with the administration computer 3 on datalink 21, and states to the computer the identity of the patient (Adam),the name of the patient's plan (ABC in this case) together with thediagnosis (sprained wrist). A computer 3 locates the file correspondingto plan ABC, confirms that the patient Adam is on the roster of insuredpersons, confirms whether the plan ABC will pay the physician for thegiven diagnosis (sprained wrist) and states the amount of reimbursement.In response, the physician can request the computer 3 to arrange atransfer of funds as payment.

If the amount of reimbursement is less than the normal charge made bythe physician, a balance would exist. The physician then gives thepatient an option of charging the balance to the patient's credit card.If the patient wishes to do so, the patient provides a suitable creditcard number, which is communicated to the computer 3, whichappropriately charges the patient's credit card account.

In addition, the computer stores the diagnosis and the amount paid tothe physician, together with other relevant data, in a separate fileassociated with the patient's name. Thus, the file for plan ABC isupdated at the time of treatment, and, further, the physician's officeitself does the updating, although in an indirect manner.

The employer which provides insurance coverage to patient 9 also hasaccess to the administration computer 3 along data link 24. However, theemployer has access to a wider range of data in the file for the ABCplan than does the physician. As stated above, the physician only hasaccess to data indicating whether or not a particular diagnosis iscovered, the amount of reimbursement, and other similar data. Incontrast, the employer has access to all data contained within the filefor the ABC plan. Further, the employer can modify the data in the file.For example, the employer can add and delete the names of insuredpersons as appropriate. Still further, the employer can change thebenefits provided by the plan ABC as needed. For example, the employercan change the types of diagnoses for which reimbursement will beallowed. The employer may decide that elective cosmetic facial surgery,as distinct from restorative facial surgery used to restore damagecaused by an accident, should not be cost borne by plan ABC, but shouldbe paid by the patient. In such a case, the employer would change thefile to so indicate.

The employer can also change the dollar amount of reimbursement for agiven diagnosis. For example, the employer may change the dollarsreimbursements for a sprained wrist from X dollars to Y dollars.

In addition, the employer Alpha can audit the operation of his own planABC. For example, the roster of insured persons is available to him, sothat he knows information as to the eligibility of his employees forinsurance benefits. Also, as mentioned above, the computer 3 stores thediagnosis and treatment information as they occur. This allows theemployer to retrieve such information and to evaluate the insuranceclaim activity of his employees. The employer can also make detailedstatistical analyses of claim activity and plan expenditures by usingthe data available. FIGS. 2-5 contain a flow chart describing in moredetail the operation of the system of FIG. 1 and will now be considered.

Block 30 in FIG. 2 indicates that a card holder (i.e., a patient) bringshis card (the card 15 in FIG. 1) to a provider site. "Provider site" isa term in the art used to refer to one who provides medical services,namely, a physician or hospital. Block 33 indicates that the card isread by an "8610". "8610" is shorthand notation for a Datatrol 8610computer terminal and associated printer indicated by numeral 18 inFIG. 1. This equipment is available from Datatrol Corporation, locatedin Minnetonka, Minn. Block 33 indicates that if the card is notreadable, then an operator at the provider site types in the client'sidentification symbol, namely, his social security number (SSN), and aclient code, which is a number identifying the ABC plan, from whichinsurance coverage is sought.

Block 36 indicates that the patient's date of birth (DOB) andrelationship to the card holder is keyed into the terminal. In thisexample, the relationship is "employee", because Adam himself is seekingtreatment. Were his wife to do so, the relationship would be "spouse".

Blocks 33 and 36 provide identification of the patient in order toassure that only the actual patient whose name is on the plan's rosterreceives medical treatment, and that no imposters do.

Block 39 refers to statement of a reason for the visit to the physicianselected from a table. One type of table includes four reasons, namely,the reasons of illness, prevention, maternity or accident. The reasonfor the visit can be important for insurance purposes because differentinsurance coverage may be available for different reasons motivating avisit. For example, plan ABC may provide maternity benefits for Adam'swife, but not his daughter. Further, some reasons, such as accident, cancause legal rights to arise for the benefit of in the plan, and sospecial procedures should be taken. For example, the YES (Y) pathleading from block 42 indicates that an accident motivated the visit tothe physician's office. Block 45 indicates that the computer terminalprompts the patient to complete a subrogation form which can givecertain subrogation rights to the plan ABC. For example, an automobileaccident may have caused the condition, so that an automobile insurancecompany may have a liability to the patient or to Plan ABC.

Block 48 indicates that the patient states whether he has previouslybeen treated for the present condition. As block 51 indicates, anotherinsurance plan may be liable to the patient for the condition. Forexample, a wife may be employed and have insurance benefits making thehusband's plan primarily liable, meaning that the patient and the wife'splan are only liable after the husband's plan pays. Block 54 indicatesthat the identity of the provider is selected (i.e., the physician) froma table of codes.

The inventors point out that, up to blocks 54 in FIG. 2A, nocommunication with the administration computer has yet been undertaken.However, at block 57, the local terminal 18 in the physician's officecommunicates data via a local telephone call to the administration(i.e., host) computer 3. Blocks 63, 66 and 68 indicate that block 71 isreached if the data base for plan ABC indicates that (1) the propersocial security number, (2) proper provider, (3) proper data of birthand (4) proper relationship have been given by the patient. If not,circles 3A and 3B are reached, as will be later discussed.

Restated, reaching block 71 indicates that the patient is not animposter. Now it must be ascertained whether the person has insurancecoverage. Block 71 indicates that the administration computer searchesthe roster to determine this. If the patient is found on the roster,then block 73 is reached. (The other situations indicated in block 71will be discussed later.) Block 73 refers to a search by theadministration computer of the data base of plan ABC to ascertainwhether the reason for the visit in block 39 in FIG. 2 is covered (i.e.,reimbursible) by plan ABC. In addition, though not indicated in FIG. 2B,block 73 can determine at this time whether the diagnosis (i.e.,sprained wrist) is covered.

If the visit is covered, block 76 refers to the assignment of anauthorization code for the transaction (i.e., treatment). Anauthorization code is a unique symbol, which identifies the transactionin an unmistakable manner as eligible for treatment. The authorizationcode functions to facilitate bookkeeping, much in the way that a serialnumber on an invoice for other purchases does so.

Block 79 refers to the creation of an eligibility record in theadministration computer. This refers to an allocation of memory space,having the authorization code as an address, in anticipation of datawhich will later be received from the physician, after treatment hasbeen completed. Block 82 indicates that the eligibility record istransmitted to the physician's terminal. This means that an indicationthat the patient is in fact on the plan's roster, together with anaffirmation that the reason for the visit is covered, is transmitted.One type of message indicating eligibility would be "eligibilityapproved". In addition, the authorization code assigned in block 76 istransmitted. The blocks in FIG. 3B following block 82 relate to errorhandling and are considered self-explanatory. The block labeled"terminate" indicates that the telephone connection is terminated.

At this time a physician has information indicating that treatment ofthe diagnosed condition is covered by insurance. Following treatment,the physician, as indicated by block 85 in FIG. 3, enters authorizationcode into his local terminal in FIG. 1. Blocks 88 and 91 indicate thatthe local terminal searches and finds the patient's name, Adam, so thatthe treatment portion of the transaction can be completed andtransmitted to the administration computer.

Block 95 indicates that the physician enters a code identifying thediagnosis (sprained wrist). Block 97 indicates that the physician entersup to ten "procedure codes", which refer to the treatments for asprained wrist selected by the physician. Blocks 101 and 104 indicatethat the diagnosis and procedure codes are now transmitted via a localtelephone call to the administration computer 3. Block 106 indicatesthat a check is made to verify that the codes received are actuallyexisting, and not fictitious, codes. Block 109 indicates that theadministration computer searches the data base for plan ABC andcalculates the reimbursement specified by the employer for eachtreatment. Block 112 indicates that these reimbursements are under theemployer's control, and will be discussed later in more detail. Block115 ascertains whether the present diagnosis (sprained wrist) is coveredby plan ABC, whether the given treatments (e.g., anaesthetics applied,immobilization by a plaster cast) are covered, the dollar amounts of thecoverage, and whether a deductible amount or a co-payment apply. Asindicated by blocks 118 and 121, data regarding the net payment whichthe plan ABC will reimburse the physician is transmitted to thephysician's terminal. A printer 130 prints the relevant data on areceipt 131, as indicated by block 125. The patient signs the receipt asacknowledgement that treatment was done. Block 135 indicates that thedata link between the physician's terminal and the administrationcomputer is then terminated.

At this point, the patient's identity has been verified, as well as hiscoverage under plan ABC (i.e., his eligibility). Also, the diagnosis andtreatments have been transmitted to the administration computer, whereinthey are stored for future use, and the administration computer hastransmitted to the physician's terminal the reimbursement amounts forthe treatments involved. It is possible that the reimbursement amountsare less than the physician's customary charges for the treatments thatthe patient owes a deductible, or that the computer 3 found the patientor the treatments to be non-insured, with the result that a balance ofpayment remains. FIG. 4 describes an option under which the patient cancharge the balance to a credit card. The YES path from block 140indicates that the charges are to be placed upon a credit card account.Block 140 indicates that the necessary information is eitherelectronically read ("swiped"), or directly types into the physician'sterminal, together with the dollar amount. At this time, the data linkis established between the physician's terminal and the administrationcomputer. Block 144 indicates that the administration computer verifieswith the bank issuing the credit card has stated that the balance amountcan be properly applied to the credit card account. If so, block 146 isreached, wherein the necessary information is printed by printer 130 inFIG. 1 upon a receipt 131, and the data link is terminated by block 148.

FIG. 5 indicates one procedure for providing plan payment to thephysician. The inquiry of block 150 refers to the authorizationdiscussed in connection with block 76 in FIG. 2B, wherein theauthorization code was established and stored. If payment wasauthorized, block 152 is reached, which indicates that a check is drawnon the client's bank account and mailed to the provider. This means thatthe administration computer prints a bank check drawing upon a bankaccount which is funded by plan ABC, or by the insurance company itself,and mailed to the provider, that is, to the physician. Block 155indicates that the administration computer maintains a record of checksprinted in block 152. The record is available to the employer and theinsurance company through data link 24 in FIG. 1. Further discussion ofsystems which accomplish the funds transfer described in FIGS. 4 and 5is found in U.S. Pat. No. 4,346,442, Musmanno, 1982, which isincorporated by reference.

If block 150 indicates that no payment was authorized, then block 157indicates that a message, indicating that payment is not authorized, issent to the physician's terminal.

The preceding discussion has been chiefly concerned with aspects ofverification. That is, verification of the patient's identity wasundertaken, verification that the diagnoses and treatments were of thetype which a give plan (ABC) would reimburse, and verification orascertainment of the dollar amounts reimbursible for each treatment.However, in some circumstances, a system of notification and tracking offormer employees may be desirable, as discussed above, in order tocomply with contractual or statuatory requirements. One such system willnow be described in connection with the following Table 1. Table 1outlines a sequence of steps taken by, and in connection with, theadministration computer.

TABLE I

1. Delete Adams, spouse, and dependents from roster of insured persons.

2. Notify Adams and perhaps others of the termination of insurancecoverage. Notify them that they have the option within X days tocontinue certain insurance benefits at stated premium rates. Send thesenotices by certified mail.

3. If notified person respond within predetermined time, indicatingdesire to purchase insurance, print and send a package of paymentcoupons for making periodic payments.

4. If participants make no response within the predetermined time,record this fact in the data base for plan ABC.

5. (Optional) If, as in paragraph 4, no response has been received,print and transmit to the former participants a second, backup notice.

Line 1 in Table 1 indicates that the Adams family is deleted from theroster of insured persons under the ABC plan, perhaps because oftermination of employment. This is done directly by the employer or datalink 24. One significant consequence of this deletion from the roster isthat, should a physician make inquiry using the physician's data link21, the administration computer has information, almost on an immediatebasis, allowing the computer to inform the physician that the Adamsfamily is no longer covered by the ABC plan. However, in some cases,discussed later, the computer may refrain from stating that the familyis not covered by the ABC plan, and instead indicate that the familypresently has an indeterminate status as to coverage.

Upon deletion of the Adams' participants from the plan, and if theemployer so requests, either at the time of deletion, or at a priortime, administration computer 3 activates a printer 170 which prints anotice which is transmitted to one or more members of the family,notifying them of the fact of termination, and offering them the optionto purchase within a stated period of time the same or similar insurancewhich they previously had, at stated premium rates. The letter istransmitted to the Adams family, and the administration computer thensets into motion a programming routine, known in the art, to track theresponse of the Adams' family, when it occurs.

If one or more of the family members respond favorably, in writing, anoperator enters the proper data into the administration computer. Inresponse, the computer, using printer 170, prints a group of paymentcoupons, which are mailed to the electing participants. The participantsreturn the coupons with payment, on a periodic basis, and the couponsassist the administration computer in tracking the payment history ofthe electing participants. The coupons bear sufficient information to dothis, and can be machine-readable by the administration computer, asknown in the art.

If no response is received in the stated time, the computer, having aninternal time clock, as known in the art, notifies the data base forplan ABC, and programming steps are taken to change the status of theAdams family from indeterminate to terminated, as will now be discussed.discussed.

As was stated earlier, it may be the case that an option was given tothe Adams family to elect to purchase insurance within a stated timeperiod. This option can be given in fulfillment of a collectivebargaining agreement, state or federal statutes, as discussed earlier,or for other reasons. Further, the option may have certain retroactiveaspects. For example, the employer may be required to give the formeremployee the right to exercise the option for a stated period of time,such as sixty days. If the option is retroactive, the following sequenceof events can occur. Termination of employment can occur on July 1. Thenotice described in Line 2 of Table 1 can be sent on the same day,July 1. The notice can be received by the employee of July 2 and thenotice can give him sixty days within which to decide whether topurchase insurance. The employee may visit a physician on July 15, butbefore he exercised the option. If he exercises the option on July 20,and pays the insurance premium as required, the ABC plan may be requiredto pay for the July 15 visit to the physician. Therefore, theadministration computer, in searching the data base in response to thephysician's inquiry on July 15, classifies the Adams family asintermediate until the option is exercised, or the option expires.

Continuing the example, if the option expires on Sept. 1, without beingexercised, and if Adams visits a physician on September 10, theadministration computer, in response to the physician's inquiry statesthat Adams is terminated from the ABC plan, and not under indeterminatestatus. Further, the classification was made by the computer immediatelyupon expiration of the option, which was a stated period, (sixty days inthis case) after mailing of the notice discussed in Line 2 of Table 1.

Several important aspects of the invention are the following:

1. As FIG. 1 indicates, an employer can add and delete beneficiaries, aswell as change provisions of a plan, by using data link 24. Further, asthe discussion above indicates, these changes can be done in real time,causing the currency of the data base to be limited only by thediligence of the employer. The fact that the data base is current hastwo significant results: first, the average lag period of fifteen days,discussed above, is eliminated. Therefore, a former employee cannotexploit the existence of the lag and obtain treatment, because treatingphysicians will be able to know immediately when an employee is deletedfrom the roster of insured persons.

A second release relates to COBRA requirements. The occurrence ofupdates to the roster can trigger the notification procedure describedabove into action. For example, detection routine, or circuit, known inthe art, detects a deletion of a person from the roster and, inresponse, immediately causes a notification to be sent, as outlined inTable 1. The immediate notification prevents COBRA mandated insurancefrom arising at the employer's expense.

These two results are similar in the respect that they both limit theliability, borne by an employer, which arises through the running oftime. Viewed another way, the same event which eliminates thefifteen-day lag in insurance termination (i.e., the event of real-timedeletion from the roster) also triggers into action the notificationprocedure of Table 1.

2. The computation of the patient's bill, discussed in connection withblock 118 in FIG. 3B, includes a computation of any deductible amountowed by the patient. This is possible because the administrationcomputer retains records of all insurance activity by the patient Adam.For example, if Adam has a One Hundred Dollar deductible amount peryear, if Adam has received no other treatment in the year, and if thecharge for the present treatment is Eighty Dollars, the entire EightyDollars is paid by Adam. This fact is indicated on the bill printed byterminal 18 in FIG. 1.

Block 118 also indicates the administration computer calculates anyco-payment amounts. This refers to amounts which the patient may berequired to co-pay with the plan ABC. For example, Plan ABC may payfully for treatments for sprained wrists, but only pay one-half forcosmetic facial surgery. In the latter case, the patient co-pays theremaining one-half.

3. The preceding discussion has been made in the context of a patientvisiting a physician. However, it should be understood that theinvention can be used by any provider of health care services, includingphysicians, dentists, hospitals, pharmacists, podiatrists, chiropodists,and psychologists. In this respect, a programming routine can be addedwhich examines whether the given provider is authorized to perform thetreatment for which payment is sought. For example, a podiatrist may notbe authorized by state law to perform some types of surgery. The limitson the treatments which a provider can perform are stored in theadministration computer, and are retrieved at the time the identity ofthe provider is verified, in block 63 in FIG. 2B. The routine preventspayments to unauthorized providers.

4. The card 15 in FIG. 1, which is carried by the patient, is the onlycard used by him, irrespective of the type of health benefits sought.That is, the patient presents the same card to his dentist, hispharmacist, his psychologist, etc.

5. A telephone connection between the physician's terminal 18 and theadministration computer, and also between the administration computerand the employer, has been discussed. The preferred telephone connectionuses a communications network, known in the art, such as Tymnet,available from McDonnel Douglas Corporation. The network allows aphysician in one city to communicate with the administration computerlocated in a different city, by making a local, non-toll, telephonecall.

6. If the patient has recently terminated employment, and then seeksmedical treatment, the administration computer, as outlined in Table 1,records the patient's insurance status as indeterminate and informs thephysician accordingly. In such a case, the physician must decide themanner in which to collect payment, as plan ABC makes no commitment atthis time.

7. The invention has been described in terms of health benefits claims.However, it is applicable to any generic plan under which a third partypays money for the benefit of a beneficiary. One example is a food stampprogram, in which a beneficiary presents food stamps (i.e., the "card"15 in FIG. 1) to a supermarket (the "provider") which can verify, usingterminal 18, whether the stamps are valid, and whether the beneficiaryis entitled to use them. In this case, the roster is a roster of foodstamp beneficiaries.

In another example, a governmental workman's compensation program istreated an analogous to plan ABC, and provides payment.

8. In addition to the verification procedures described above forverifying the identity of the patient, other procedures can be used.Voiceprint, fingerprint, and signature verification can be used, asknown in the art.

9. From one point of view, the invention allows the physician to onlyaddress and read the data base, while the employer can address, read,and, in addition, modify the data base, as by deleting beneficiaries.(Of course, the physician, in a sense, can modify the data base, becausethe treatments which he performs are stored by the administrationcomputer. However, this type of modification does not affect thebenefits available to beneficiaries. The employer can modify thebenefits.

10. FIG. 4 describes an optional procedure by which a patient can paythe balance which plan ABC does not cover. FIG. 5 describes a procedureby which plan ABC pays the physician.

11. Plan ABC has been described as an insurance plan. However, it neednot be such. Plan ABC can be a self-insurance plan of the employer, orany entity which provides benefits to beneficiaries for specified typesof health care.

An invention has been described wherein a physician, at the time andlocation of rendering medical treatment, obtains information as to theamount of payment for the treatment, and also, in some cases, actualpayment itself. The information is obtained from a database which isupdated, in real time, by the employer providing the insurance.

Numerous substitutions and modifications can be undertaken withoutdeparting from the true spirit and scope of the invention as defined inthe claims.

What is claimed is:
 1. Apparatus for updating a central data baseconsisting of the identities of beneficiaries who at a point in time aremembers of an employment group having post-membership option rights forcontinuing health care benefits comprising:a file of predetermined timespans between active and pending states of benefit plan eligibilitybased on the status of association between the beneficiary and theemployment group; a clock function means responsive to changes inbeneficiary member status for updating the beneficiary plan eligibilitystate in the file at said predetermined time spans; and a two-way datacommunication link between at least one benefit provider and the filefor inputting member identification information and receiving currentdata representing the status of the beneficiary relevant to theemployment group and plan eligibility during both active and pendingstatus periods.
 2. Apparatus as defined in claim 1 further includingmeans for generating a notification to a group member upon theoccurrence of a change in status.
 3. Apparatus as defined in claim 2wherein the notification includes information regarding continuingbenefit plan options.
 4. For use in combination with a central data basewhich is maintained by a health care benefit plan administrator andwhich consists of at least (a) employment group member identificationdata, (b) employment group member benefit eligibility status data, (c)defined benefit payment amounts and (d) a clock function which modifiesthe plan eligibility status data for individual employment group membersat appropriate times related to a change in employment group membershipstatus:a two-way data communication apparatus for location at a benefitprovider station which is remote from the central data base and whichincludes: means for inputting beneficiary identification data andsending such identification data to the central data base forverification as to the association between the proposed beneficiary andthe employment group benefit plan and, according to said clock function,the status of beneficiary eligibility; means for receiving anddisplaying proposed beneficiary eligibility confirmation from thecentral data base as a result of the inputting of beneficiaryidentification data; means for inputting proposed benefit identificationdata and sending such benefit identification data to the central database; means for receiving and displaying the payment amount data fromthe central data base which corresponds to the previously inputtedproposed benefit identification data; and means for inputting andsending to the central data base a payment request based on the proposedbenefit payment amount.
 5. Apparatus as defined in claim 4 furtherincluding a two-way data communication link between said devices and thecentral data base.
 6. Apparatus as defined in claim 5 further includingmeans for updating the contents of the central data base to show bothactive and pending states of benefit plan eligibility for eachbeneficiary whose identification data is in the central data base. 7.Apparatus as defined in claim 6 further including notice generatingmeans interconnected with said central data base for receiving datarepresenting changes in status of a beneficiary relative to theemployment group and for generating notices of benefit plan eligibilityand options associated with said eligibility for transmission tobeneficiaries/employment group members; andclock means for initiatingactivation of said notice generating means a regulated time spanfollowing an employment group membership status change.
 8. For use incombination with the central data base which is maintained by a healthcare benefit plan administrator and which consists of at least (a)employment group member identification data, (b) employment group memberbenefit eligibility status data, (c) defined benefit payment amounts and(d) a clock function means which modifies the plan eligibility statusdata for individual employment group members at appropriate timesrelated to a change in employment group membership status;a two-way datacommunication apparatus for location at a benefit provider station whichis remote from the central data base and which includes: means forinputting beneficiary identification data and sending suchidentification data to the central data base for verification as to theassociation between the proposed beneficiary and the employment groupbenefit plan and, according to said clock function means, the status ofbeneficiary eligibility; means for receiving and displaying proposedbeneficiary eligibility confirmation from the central data base as aresult of the inputting of beneficiary identification data; means forinputting proposed benefit identification data and sending such benefitidentification data to the central data base; and means for receivingand displaying the payment amount data from the central data base whichcorresponds to the previously inputted proposed benefit identificationdata.
 9. For use in combination with the central data base which ismaintained by a health care benefit plan administrator and whichconsists of at least (a) employment group member identification data,(b) employment group member benefit eligibility status data, (c) definedbenefit payment amounts and (d) a clock function means which modifiesthe plan eligibility status data for individual employment group membersat appropriate times related to a change in employment group membershipstatus;a two-way data communication apparatus for location at a benefitprovider station which is remote from the central data base and whichincludes: means for inputting beneficiary identification data andsending such identification data to the central data base forverification as to the association between the proposed beneficiary andthe employment group benefit plan and, according to said clock functionmeans, the status of beneficiary eligibility; and means for receivingand displaying proposed beneficiary eligibility confirmation from thecentral data base as a result of the inputting of beneficiaryidentification data.